As the new Administration is presented with great challenges facing the United States, one will be a longtime foe, the U.S. HIV/AIDS epidemic. Since President Barack Obama was elected in 2008, I have publicly called on our country's leaders to utilize the largest global health initiative in history - the President's Emergency Plan for AIDS Relief (PEPFAR) - as a model to address the U.S. epidemic. This historical global health initiative, which uniquely put a real dent in the global HIV/AIDS crises, was launched in 2003 by President George W. Bush. Across all of sub-Saharan Africa, fewer than 50,000 people were on treatment in 2002. To save lives and decrease transmission of HIV, as of September 30, 2015 (www.pepfar.gov), PEPFAR has supported lifesaving antiretroviral treatment (ART) for 9.5 million men, women, and children--a more than four-fold increase since the beginning of President Obama's administration. Needless to say, it has been enormously successful as it paired government, academia and local organizations together to tackle a growing, unruly public health crisis.
At the end of 2012, an estimated 1.2 million persons aged 13 and older were living with HIV infect on in the United States, including 156,300 (12.8%) persons whose infections had not been diagnosed (CDC. Prevalence of Diagnosed and Undiagnosed HIV Infection -- United States, 2008-2012. MMWR 2015; 64:657-662).
Our Institute of Human Virology (IHV) at the University of Maryland School of Medicine in Baltimore, Maryland has reached well over one million in HIV care and treatment overseas through PEPFAR while locally caring for close to 6,000 HIV infected individuals annually at our Baltimore clinics. We know PEPFAR works, and we undoubtedly see the need for a similar program in the U.S.
In Baltimore, one in 43 people over the age of 13 is infected with HIV, according to the Maryland Department of Health and Mental Hygiene. Most of the time, those that are infected fail to, or are unable to, seek proper care. Youth ages 13-24 are the fastest growing group of new HIV infections. More than 50 percent of youth with HIV do not know they are infected.
A comparable domestic program for inner cities and the rural south, which are the regions hardest hit in America's HIV epidemic, doesn't just begin to achieve the U.S. government's goal of an "AIDS-free generation," but it could provide access to prescribed care and medical therapies so that patients with HIV can live a normal lifespan (many don't even realize this is possible).
Federal and state officials have already allocated enormous sums to fight bioterrorism. But in years past, more Americans have been the victims of HIV/AIDS than have been affected or killed by any bioterrorist attack. In any case, a focused domestic program would certainly help prepare people in the event of a bioterrorist attack.
Education and testing are key to managing and preventing HIV infection. This country needs a program that can teach people about prevention and early detection. As long as adverse socioeconomic conditions prevail, those living in HIV/AIDS "hot spots" without education about the disease and facing other life challenges -- such as mental illness, drug abuse, homelessness and lack of health insurance -- will be at risk even if we do develop an AIDS vaccine. When an AIDS vaccine does become available, a program to reduce HIV infection would ensure that our nation is prepared to readily distribute the medicine.
In countries like Botswana and Rwanda, IHV has helped bring about viral suppression for 80% or more of the HIV infected population. That means they will not be transmitting the virus such that the number of new infections will wane significantly in those countries. Clearly, that same opportunity exists in the United States, although the current percentage of our HIV-infected population whose vial load is suppressed is much lower. Yet, we are behind these African countries in bringing the epidemic under control.
Unless we develop a program to fight HIV infection, our urban centers and the rural south will continue to face an even more daunting epidemic. To improve the health of millions of Americans and to reduce HIV infection rates, the next administration should craft and implement a domestic HIV/AIDS plan targeting our inner cities and the rural south.